End of an Era

An era is coming to an end. Bracketed by the Flexner Report of 1910 and the arrival of Artificial Intelligence in Healthcare, medicine depended daily on the doctor being well schooled in bioscience and charged with delivering good decisions based on rationale, existing agreed best practice, personal and communal experience and respecting the patient's preferences and the healthcare system's capabilities and limitations. At the outset this was as good as it might be. But it wasn't that good. Existing best practice was no more than a consensus view with little evidence to support it. Personal experience was seldom recorded and relied on the recall of the practitioner who had few numerical data to help and whose recall of outcomes would be partial and most likely selective. Rationale, rooted in a thorough grasp of best scientific knowledge seemed the key redource yet has subsequently been shown to be an unreliable source of effective guidance. The capabilities of the system to deliver were by modern standards extremely limited. The patient's preferences were of course available and could be respected but limited by the aforementioned fragile contributions. Now we have robust evidence on best actions in an increasing range of situations, with AI to carry and dispense the data and guide non science based practitioners.